What counts as psychopathology?

Sami Timimi in his recent book, Searching for normal, describes how the diagnoses of autism and ADHD have changed over the years. They have gone from uncommon conditions to being widespread. As Sami says:-

From rare diagnoses given to kids with significant learning difficulties or active and mischievous boys, autism and ADHD follow an impressive developmental trajectory out of the confines of child guidance clinics and into the belly of mass culture.

When Sami and I trained, mental health problems in children were mainly separated into conduct disorders and emotional disorders. There was little attempt to categorise children’s behaviour and emotions into psychiatric diagnoses, as in adult psychiatry. The focus was on family therapy with attempts made to formulate hypotheses about the functioning of the child in the context of the family and community.

Sami describes how the diagnostic ideology of adult psychiatry has invaded child psychiatry, introducing a “culture of pathologising, labelling and medicating”. As he says, “There has never been a generation of young people so colonised at such a young age by mental health propaganda”. In fact, child psychiatry has been an exporter of diagnoses to adult psychiatry leading to a ballooning of ADHD and autism in adults.  People can identify with these diagnoses, which then seem to provide explanations for their personal difficulties. 

Of course it’s important to try to understand the reasons for personal difficulties. But the reasons can’t be proven as such, which is why it’s tempting to latch onto a psychiatric diagnosis that may seem to provide an external explanation. But such states may be better appreciated as understandable responses to the situation in which the person finds themself. It’s not always easy to maintain a positive sense of self. A psychiatric diagnosis may not necessarily provide a valid explanation for any negative views of oneself and situation, particularly if that diagnosis is supported by unproven speculations about brain pathology. We all need myths to live by and whatever relief a diagnosis may appear to provide, it does need to have sound foundations. We do seem to be inflating the value of pathologising everyday difficulties, certainly in terms of the brain (see eg. previous post).